Hospital Resource Utilization and Costs in Patients with Heart Failure in France.
Journal
PharmacoEconomics - open
ISSN: 2509-4254
Titre abrégé: Pharmacoecon Open
Pays: Switzerland
ID NLM: 101700780
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
accepted:
16
07
2023
medline:
15
9
2023
pubmed:
15
9
2023
entrez:
15
9
2023
Statut:
ppublish
Résumé
Heart failure (HF) is one of the leading causes of morbidity and mortality, and economic burden on the healthcare system. The aim of this study was to estimate the current hospital resource utilization and costs for HF patients in France. This retrospective cohort study included adult HF patients hospitalized in France between January 1, 2019 and December 31, 2019. Data related to sociodemographic characteristics, number and duration of hospital stays, use of medical procedures or expensive and innovative drugs/medical devices included in the "liste-en-sus", and comorbidities were retrieved from the French national hospital discharge database. Data were further stratified based on the presence or absence of cardiac decompensation, comorbidities, ejection fraction (EF) status, and incident/prevalent patients. In 2019, a total of 430,544 patients were hospitalized in France with HF as a primary or associated diagnosis, with 51.9% male and 48.1% female and a mean age of 79.0 years. More than 75% of the study population was composed of prevalent HF patients. About 3.1% of patients were diagnosed with at least one event of cardiac decompensation during follow-up. Also, 20.2% and 9.9% of patients were identified with preserved and reduced EFs, respectively. The average number and length of hospital stays were 1.7 per patient and 10.4 days per patient, respectively. The annual cost of hospitalization for HF was €8341.3 per patient. Presence of cardiac decompensation at index date or during follow-up, reduced EF, and comorbidities were associated with numerically higher frequency and length of hospitalization, and hospitalization cost. For hospitalization and 'liste-en-sus' medical devices, higher cost was observed in incident than prevalent HF patients, while for 'liste-en-sus' drugs, higher cost was reported in prevalent than incident HF patients. This study highlighted the high economic hospital burden of HF in France. More studies investigating different HF patient profiles must be conducted to help determine the main factors of hospital cost for HF.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Heart failure (HF) is one of the leading causes of morbidity and mortality, and economic burden on the healthcare system. The aim of this study was to estimate the current hospital resource utilization and costs for HF patients in France.
METHODS
METHODS
This retrospective cohort study included adult HF patients hospitalized in France between January 1, 2019 and December 31, 2019. Data related to sociodemographic characteristics, number and duration of hospital stays, use of medical procedures or expensive and innovative drugs/medical devices included in the "liste-en-sus", and comorbidities were retrieved from the French national hospital discharge database. Data were further stratified based on the presence or absence of cardiac decompensation, comorbidities, ejection fraction (EF) status, and incident/prevalent patients.
RESULTS
RESULTS
In 2019, a total of 430,544 patients were hospitalized in France with HF as a primary or associated diagnosis, with 51.9% male and 48.1% female and a mean age of 79.0 years. More than 75% of the study population was composed of prevalent HF patients. About 3.1% of patients were diagnosed with at least one event of cardiac decompensation during follow-up. Also, 20.2% and 9.9% of patients were identified with preserved and reduced EFs, respectively. The average number and length of hospital stays were 1.7 per patient and 10.4 days per patient, respectively. The annual cost of hospitalization for HF was €8341.3 per patient. Presence of cardiac decompensation at index date or during follow-up, reduced EF, and comorbidities were associated with numerically higher frequency and length of hospitalization, and hospitalization cost. For hospitalization and 'liste-en-sus' medical devices, higher cost was observed in incident than prevalent HF patients, while for 'liste-en-sus' drugs, higher cost was reported in prevalent than incident HF patients.
CONCLUSION
CONCLUSIONS
This study highlighted the high economic hospital burden of HF in France. More studies investigating different HF patient profiles must be conducted to help determine the main factors of hospital cost for HF.
Identifiants
pubmed: 37713172
doi: 10.1007/s41669-023-00431-0
pii: 10.1007/s41669-023-00431-0
doi:
Types de publication
Journal Article
Langues
eng
Pagination
927-940Informations de copyright
© 2023. The Author(s).
Références
Hajouli S, Ludhwani D. Heart failure and ejection fraction. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2022.
McMurray JJ, Adamopoulos S, Anker S, et al. Erratum: ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 (European Journal of Heart Failure (2012) 14 (803–869)). Eur J Heart Fail. 2013;15(3):361–2.
doi: 10.1093/eurjhf/hft016
Lippi G, Sanchis-Gomar F. Global epidemiology and future trends of heart failure. AME Med J. 2020;5(15):1–6.
Givertz MM, Stevenson LW, Colucci WS. Strategies for management of decompensated heart failure. In: Cardiovascular therapeutics: Elsevier; 2007. p. 385-409.
Gabet A, Juillière Y, Lamarche-Vadel A, Vernay M, Olié V. National trends in rate of patients hospitalized for heart failure and heart failure mortality in France, 2000–2012. Eur J Heart Fail. 2015;17(6):583–90.
doi: 10.1002/ejhf.284
pubmed: 25950872
Constantinou P, Pelletier-Fleury N, Olié V, Gastaldi-Ménager C, JuillÈre Y, Tuppin P. Patient stratification for risk of readmission due to heart failure by using nationwide administrative data. J Card Fail. 2021;27(3):266–76.
doi: 10.1016/j.cardfail.2020.07.018
pubmed: 32801005
World Health Organization. Adult mortality rate (probability of dying between 15 and 60 years per 1000 population). 2018. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/adult-mortality-rate-(probability-of-dying-between-15-and-60-years-per-1000-population ). Accessed 14 Sep 2022.
L’Assurance Maladie. Insuffisance cardiaque. 2022. https://data.ameli.fr/pages/pathologies/?refine.patho_niv1=Maladies%20cardio-neurovasculaires&refine.patho_niv2=Insuffisance%20cardiaque . Accessed 22 Aug 2022.
Institut national d'études démographiques. Décès totaux par sexe. 2021. https://www.ined.fr/fr/tout-savoir-population/chiffres/france/mortalite-cause-deces/deces-sexe/ . Accessed 14 Sep 2022.
Biermann J, Neumann T, Angermann CE, et al. Resource use and costs in systolic heart failure according to disease severity: a pooled analysis from the German Competence Network Heart Failure. J Public Health. 2012;20(1):23–30.
doi: 10.1007/s10389-011-0452-0
Stålhammar J, Stern L, Linder R, et al. Resource utilization and cost of heart failure associated with reduced ejection fraction in Swedish patients. J Med Econ. 2012;15(5):938–46.
doi: 10.3111/13696998.2012.686464
pubmed: 22510016
L'assurance Maladie. Améliorer La Qualité Du Système De Santé Et Maîtriser Les Dépenses. 2022. https://assurance-maladie.ameli.fr/sites/default/files/2022-07_rapport-propositions-pour-2023_assurance-maladie_3.pdf . Accessed.
Caisse Nationale d’Assurance Maladie. Méthodologie médicale de la cartographie des pathologieset des dépenses, version G7. 2020. https://assurance-maladie.ameli.fr/sites/default/files/2020_methode-reperage-pathologies_cartographie.pdf . Accessed 22 Feb 2023.
Braunwald E. Diabetes, heart failure, and renal dysfunction: The vicious circles. Prog Cardiovasc Dis. 2019;62(4):298–302.
doi: 10.1016/j.pcad.2019.07.003
pubmed: 31377223
Ministère de la Santé et de la Prévention. Étude nationale de coûts à méthodologie commune (ENCC) 2023. https://sante.gouv.fr/professionnels/gerer-un-etablissement-de-sante-medico-social/financement/financement-des-etablissements-de-sante-10795/financement-des-etablissements-de-sante-glossaire/article/etude-nationale-de-couts-a-methodologie-commune-encc . Accessed 22 Feb 2023.
Sante' publique France. Insuffisance cardiaque. 2019. https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-cardiovasculaires-et-accident-vasculaire-cerebral/insuffisance-cardiaque . Accessed 14 Sep 2022.
L’Assurance Maladie. Caractéristiques et trajet de soins des insuffisants cardiaques du régime général. 2012. https://assurance-maladie.ameli.fr/etudes-et-donnees/2012-caracteristiques-trajet-soins-insuffisants-cardiaque . Accessed 16 Aug 2022.
Pérel C, De Peretti C, Juilliere Y, Alla F, Danchin N, Tuppin P. Taux de patients hospitalisés pour insuffisance cardiaque en 2008 et évolutions en 2002–2008, France. Bulletin épidémiologique hebdomadaire. 2012;41:466–70.
Tuppin P, Rivière S, Rigault A, et al. Prevalence and economic burden of cardiovascular diseases in France in 2013 according to the national health insurance scheme database. Arch Cardiovasc Dis. 2016;109(6–7):399–411.
doi: 10.1016/j.acvd.2016.01.011
pubmed: 27079468
Chang PP, Chambless LE, Shahar E, et al. Incidence and survival of hospitalized acute decompensated heart failure in four US communities (from the Atherosclerosis Risk in Communities Study). Am J Cardiol. 2014;113(3):504–10.
doi: 10.1016/j.amjcard.2013.10.032
pubmed: 24342763
Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451–61.
doi: 10.1056/NEJMoa2107038
pubmed: 34449189
Packer M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med. 2020;383(15):1413–24.
doi: 10.1056/NEJMoa2022190
pubmed: 32865377
Kebede B, Dessie B, Getachew M, Molla Y, Bahiru B, Amha H. Clinical characteristics, management, and length of hospital stay between patients with new-onset and acute decompensated chronic heart failure: a prospective cohort study in Ethiopia. Res Rep Clin Cardiol. 2021;12:57.
Whellan DJ, Zhao X, Hernandez AF, et al. Predictors of hospital length of stay in heart failure: findings from Get With the Guidelines. J Card Fail. 2011;17(8):649–56.
doi: 10.1016/j.cardfail.2011.04.005
pubmed: 21807326
Tirfe M, Nedi T, Mekonnen D, Berha AB. Treatment outcome and its predictors among patients of acute heart failure at a tertiary care hospital in Ethiopia: a prospective observational study. BMC Cardiovasc Disord. 2020;20(1):1–10.
doi: 10.1186/s12872-019-01318-x
Hauck K, Zhao X. How dangerous is a day in hospital? A model of adverse events and length of stay for medical inpatients. Med Care. 2011;49(12):1068–75.
doi: 10.1097/MLR.0b013e31822efb09
pubmed: 21945976
Dunlay SM, Shah ND, Shi Q, et al. Lifetime costs of medical care after heart failure diagnosis. Circ Cardiovasc Qual Outcomes. 2011;4(1):68–75.
doi: 10.1161/CIRCOUTCOMES.110.957225
pubmed: 21139091
Bogner HR, Miller SD, de Vries HF, Chhatre S, Jayadevappa R. Assessment of cost and health resource utilization for elderly patients with heart failure and diabetes mellitus. J Card Fail. 2010;16(6):454–60.
doi: 10.1016/j.cardfail.2010.01.007
pubmed: 20610226
pmcid: 2911028
Liao L, Anstrom KJ, Gottdiener JS, et al. Long-term costs and resource use in elderly participants with congestive heart failure in the Cardiovascular Health Study. Am Heart J. 2007;153(2):245–52.
doi: 10.1016/j.ahj.2006.11.010
pubmed: 17239685
Liao L, Jollis JG, Anstrom KJ, et al. Costs for heart failure with normal vs reduced ejection fraction. Arch Intern Med. 2006;166(1):112–8.
doi: 10.1001/archinte.166.1.112
pubmed: 16401819
Harjai KJ, Nunez E, Turgut T, et al. The independent effects of left ventricular ejection fraction on short-term outcomes and resource utilization following hospitalization for heart failure. Clin Cardiol. 1999;22(3):184–90.
doi: 10.1002/clc.4960220306
pubmed: 10084060
Bosco-Lévy P, Duret S, Picard F, et al. Diagnostic accuracy of the International Classification of Diseases, Tenth Revision, codes of heart failure in an administrative database. Pharmacoepidemiol Drug Saf. 2019;28(2):194–200.
doi: 10.1002/pds.4690
pubmed: 30395375
L' Assurance Maladie. Améliorer La Qualité Du Système De Santé Et Maîtriser Les Dépenses. 2021. https://assurance-maladie.ameli.fr/sites/default/files/2021-07_rapport-propositions-pour-2022_assurance-maladie_3.pdf . Accessed 14 Sep 2022.